腹腔镜肠粘连松解术用于小儿肠梗阻的效果  

Effect of Laparoscopic Intestinal Adhesiolysis in Children With Intestinal Obstruction

作　　者：段永福[1] 姚丹丹 梅孝臣 赵成鹏[1] Duan Yongfu;Yao Dandan;Mei Xiaochen(Department of Pediatric Surgery, Nanyang Central Hospital, Nanyang 473000, China)

机构地区：[1]河南省南阳市中心医院小儿外科,南阳473000

出　　处：《中国微创外科杂志》2020年第6期507-511,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨小儿肠梗阻腹腔镜肠粘连松解术的效果,以及对应激指标、肠蠕动功能等的影响。方法回顾性分析2017年1月~2019年12月106例小儿粘连性肠梗阻肠粘连松解术的临床资料,家属选择手术方式,行腹腔镜手术和开腹手术各53例。比较2组手术指标,术前、术后1 d、术后3 d胃肠道功能和应激指标。结果腹腔镜组手术时间、肛门排气时间、下床活动时间以及住院时间均明显较开腹组短[(60.2±8.2)min vs.(80.1±8.2)min,t=-12.470,P=0.000;(30.1±10.1)h vs.(46.3±15.6)h,t=-6.331,P=0.000;(23.6±1.6)h vs.(43.2±3.9)h,t=-33.363,P=0.000;(4.0±0.6)d vs.(8.9±1.4)d,t=-23.720,P=0.000],且术中出血少[(61.2±8.1)ml vs.(115.4±16.9)ml,t=-21.086,P=0.000],并发症少[3.8%(2/53)vs.20.8%(11/53),χ^2=7.102,P=0.008]。术后2组胃动素(motilin,MOT)、胃泌素(gastrin,GAS)、二胺氧化酶(diamine oxidase,DAO)均较治疗前降低(P<0.05),腹腔镜组MOT、GAS明显高于开腹组(P<0.05),DAO明显低于开腹组(P<0.05)。术后1 d 2组超氧化物歧化酶(superoxide dismutase,SOD)均较术前降低(P<0.05),丙二醛(malondialdehyde,MDA)均较术前升高(P<0.05);术后3 d腹腔镜组SOD、MDA均恢复到术前水平(P>0.05),开腹组与术前仍存在明显差异(P<0.05)。结论与开腹手术相比,腹腔镜肠粘连松解术手术时间短,对应激和胃肠道功能影响小,术后恢复快。Objective To discuss the effect of laparoscopic intestinal adhesiolysis in children with intestinal obstruction,and to compare and analyze the effect of laparoscopic intestinal adhesiolysis on children’s stress index and intestinal peristalsis function.Methods The clinical data of 106 children with adhesive ileus who underwent intestinal adhesiolysis from January 2017 to December 2019 were retrospectively analyzed.Their parents chose the surgical method,including 53 cases of laparoscopic surgery and 53 cases of open surgery.The indexes of operation,gastrointestinal function and stress before operation,1 day after operation and 3 days after operation were compared between the two groups.Results The laparoscopic group had significantly shorter operation time,anal exhaust time,ambulation time and hospital stay than the open group[(60.2±8.2)min vs.(80.1±8.2)min,t=-12.470,P=0.000;(30.1±10.1)h vs.(46.3±15.6)h,t=-6.331,P=0.000;(23.6±1.6)h vs.(43.2±3.9)h,t=-33.363,P=0.000;(4.0±0.6)d vs.(8.9±1.4)d,t=-23.720,P=0.000],less blood loss[(61.2±8.1)ml vs.(115.4±16.9)ml,t=-21.086,P=0.000],and lower complication rate[3.8%(2/53)vs.20.8%(11/53),χ^2=7.102,P=0.008].The motilin(MOT),gastrin(GAS)and diamine oxidase(DAO)were decreased in both groups after operation as compared with before treatment(P<0.05).The MOT and GAS in the laparoscopic group were significantly higher than those in the open group(P<0.05),and the DAO was significantly lower than that in the open group(P<0.05).At 1 day after operation,the superoxide dismutase(SOD)was lower and malondialdehyde(MDA)was higher in both groups than before operation(P<0.05).At 3 days after operation,the SOD and MDA in the laparoscopic group returned to preoperative levels(P>0.05),but there were still significant differences in the open group(P<0.05).Conclusion Compared with open surgery,laparoscopic intestinal adhesiolysis has shorter operation time,less impact on stress and gastrointestinal function,and faster recovery after operation.

关 键 词：腹腔镜 肠粘连松解术 粘连性肠梗阻 围术期指标 应激指标 胃肠功能 

分 类 号：R65[医药卫生—外科学]